Jordan

How A Fragile WASH Sector Threatens Jordan’s COVID Response

Miranda Wolford and Hadeel Hamoud

As many other countries in the Middle East and North Africa faced mounting infection rates, Jordan stood out for the early steps it took to close its borders and limit the spread of the COVID-19 virus among its population. In mid-March, the kingdom was one of the first countries in the region to shut its airports and borders for non-essential goods. The government imposed a strict, preventative lockdown and mandated quarantine for all travelers, including tourists. These initial lockdown measures explain the country’s early and successful control over the spread of the virus and low rate of infections. By June, the pandemic situation was classified as “moderate risk”.

After the country officially reopened its borders in early September, Jordan has seen a troubling spike in cases. By September 10, the Kingdom, which has a population of almost 10 million people, saw 3,314 confirmed cases with 2,206 recoveries and 24 deaths. As of October 2, there have been 15,640 cases with 1,776 new cases added October 1, the highest daily increase since the first confirmed case in the country in March. Weak and overburdened healthcare and WASH sectors in the midst of widespread poverty before the pandemic partly explain Jordan’s struggle to return to maintain control over the virus.

Source: World Bank

EFFECTIVE GOVERNMENT RESPONSE

With only a single case of the coronavirus in March, Jordan implemented a swift, severe and preventative lockdown, curtailing a widespread COVID-19 outbreak. In the week after the first confirmed case on March 2nd, Jordan’s health ministry struggled to impose a quarantine of suspected cases and many individuals criticized strict measures, failing to take the spread of virus seriously. As a result, on March 17, the government resorted to emergency laws. The government’s lockdown that ensued before the outbreak gained momentum and successfully contained the virus in the short term resulting in low case numbers and health costs compared to the rest of the world.

POSITIVE RECEPTION

Jordan received praise from international institutions and figures alike for its innovative yet decisive COVID-19 response strategy, especially given the high numbers of refugees within the Kingdom. United Nations High Commissioner for Refugees Filippo Grandi, in particular, praised the Kingdom for its inclusive strategy in a visit in mid-September: “Jordan has been extremely positive from the point of view of humanitarian assistance by including refugees [and] ensuring that refugees would not be excluded from the care provided to [COVID] patients.”

Moreover, Jordan’s technology-enabled approach to reopening its education system during COVID-19 has seen positive results thus far. In partnership with the World Bank, the Ministry of Education and Ministry of Digital Economy and Entrepreneurship invested in a multitude of online learning platforms (Edraak, Mawdoo3, Abwaab and JoAcademy) to take grades 1 to 12 entirely online. Instead of in-person instruction, teachers and students were able to watch videos and trainings via these applications. Jordan’s sports channel was even repurposed to a student learning channel. With over 103 million students out of school across the Middle East and North Africa, Jordan stands as a leader in its educational adaptations to COVID-19 with its early successes. Looking forward, the Ministry of Education is exploring remote gig economy trainings for refugees in particular with Hsoub Academy.

Timeline

Purple: Public health measures; Orange: health system response; Blue: socio-economic measures

March 2: First COVID-19 case in Jordan confirmed

March 14: Jordan announces lockdown, ordering all citizens to stay home apart from emergencies and banning travel between provinces. All government institutions closed except hospitals. Airspace and land border crossings closed. All shops closed except those selling food and medicine. Gatherings of more than 10 people banned. Army troops deployed around Amman, Jordan’s capital, and on highways between provinces.

March 17: King Abdullah approves a royal decree that activates the country’s 1992 Defense Law which gives the government sweeping powers to enforce a state of emergency. Reinforces lockdown measures. Conditional release of detainees and prisoners.

March 19: Jordanian Armed Forces sealed Amman, which has over 4 million residents.

March 23: Jordan launched a doorstep delivery service to provide basic supplies such as bread, water, and medicine. Municipalities, water companies, and large businesses that normally deliver to local businesses will also deliver.

April 9: Government implements 48-hour curfew.

April 14: Jordan bans public worship in mosques during Ramadan.

May 21: Government imposes a new three-day shutdown after a spike in new cases.

June 6: Business activities, cafes, and restaurants reopen. Ban on travel between cities lifted. Residents able to use vehicles between 6am and 12pm without need for special permits. Domestic flights will resume.

August 12: Spread of cases from Syria prompted Jordan to impose a week-long closure of the Jaber border crossing (trade route for Syrian and Lebanese goods to the Gulf and Iraq).

August 17: Jordan places Ramtha city, a city near the Syrian border, on lockdown following largest daily rise in 4 months.

September 8: Two cases confirmed in Azraq camp. First cases in Jordan’s Syrian refugee camps.

September 10: Three cases confirmed in Zaatari camp, Jordan’s largest Syrian refugee camp.

September 8: Reopened airport to international flights.

September 14: Government announced all restaurants, cafes, mosques, and public markets would be closed for two weeks from Thursday September 17 to stem the recent surge in infections. Classes at public and private schools will be remote for the two week period. Grades 1-3 and 12 will be allowed to attend in-person classes.

STRUGGLING ECONOMY

In 2020, Jordan ranked 110th in the world in terms of GDP per capita. 15.7% of the Jordanian population and 78% of the Syrian population live under the poverty line. Unemployment before the coronavirus pandemic was 19.1%. Public debt in Jordan was equal to 99.1% of its GDP in 2019.

In response to Jordan’s economic downturn, Jordan’s Minister of Finance Mohamad Al-Ississ spoke with the International Monetary Fund in July to give his perspective. Bluntly, he stated that the expectation is for “Jordan’s economy to contract in 2020 — for the first time in decades.” After years of rapid economic growth and globalized economic opportunities, a contraction represents a severe decrease in sectors like tourism, trade, remittances, and foreign investment. However, he spoke optimistically about Jordan’s burgeoning technology startup space as having high potential both for impact and economic growth amidst COVID-19.

FRAGILE WASH SECTOR

Water, Sanitation and Hygiene

Jordan suffers from severe water scarcity and high urban population density, challenging water, sanitation, and hygiene standards. About 4 million of the country’s 10 million inhabitants are concentrated in Amman and surrounding areas. Moreover, Jordan is the second ost water scarce country in the world. Days after imposing the nationwide lockdown in March, the Ministry of Water and Irrigation announced that demand for water increased by 40%. The number of water complaints increased by 60%. Nevertheless, Water Minister Raed Abdul Saud stated “We reassure people that water supply across the board is going smoothly despite the huge increase in water consumption” operating its “water resources and mega projects, such as the Disi Water Conveyance Project, at their maximum capacity”. Despite its water scarcity, 98% of Jordan’s population has access to an improved water source.

Water is usually available once a week in urban areas and less than once every two weeks in rural areas. Only 77.3% of existing sanitation systems are safely managed and only a third of schools have basic sanitation services. To strengthen weak WASH sectors throughout the country, UNICEF established quarantine areas in Azraq camp and King Abdullah Park including latrines and showering areas accessible for people with disabilities. Per UNICEF’s initial analysis, they targeted such efforts towards refugee camps given that they house more vulnerable populations. However, UNICEF, the lead UN agency for the WASH sector in Jordan, has since put forth a budget of $22.7 million to target the whole country with better communication and response strategies, more healthcare supplies, soap and hygiene kits especially for refugee communities, and increased social support programs for children and domestic violence victims. A WASH hotline remains operational and responds to concerns from the community to ensure uninterrupted access to WASH services. A mobile app, developed in partnership between UNICEF and the Ministry of Water and Irrigation, has also been implemented to help families track and manage their water utilities.

Health facilities

According to the World Bank, before the pandemic, the Kingdom had low health care capacity. Hospitals in Jordan have 1.4 beds per 1,000 inhabitants which is about half the world average. The World Health Organization (WHO) ranked Jordan’s health care system as one of the least prepared for a pandemic, and the International Health regulation score placed Jordan worse prepared than Lebanon, Morocco, and Sudan. About 7.6% of Jordan’s GDP goes towards national health expenditures of which 29% represents out-of-pocket expenditures.

Jordan’s expansive NGOs and local community-based organizations as well as international support have enhanced government efforts to raise awareness and sustain delivery of health services, particularly to refugee communities. The UNHCR has assisted over 43,000 newly vulnerable families severely impacted by COVID-19 to cover their most vital and essential needs. Moreover, the Government of Jordan endorsed the Jordan Response Plain (JRP) which aligns all sectors with SDGs and areas in need of support according to the Global Compact on Refugees (GCR).

Refugee communities

On September 8, the UNCR confirmed two coronavirus cases in the Azraq camp for Syrian refugees, home to more than 40,000 people. These are the first infections detected among Syrians living in refugee camps in Jordan. The two patients were sent to quarantine facilities in the Dead Sea and their contacts have been isolated and tested. On September 10, the UNHCR confirmed three cases in the Zaatari camp, Jordan’s largest camp for Syrian refugees hosting almost 77,000 Syrians.

Since the beginning of the pandemic outbreak, refugees in Jordan, in urban areas and in camps, have been included in the National Health Response Plan and are able to access national health services on par with Jordanian nationals. However, UNHCR officials and other aid agencies worry that a lack of resources, overcrowding, and poor sanitation pre-COVID will exacerbate the spread of the virus in Jordan’s refugee camps. Consequently, Jordan’s health ministry is conducting thousands of tests, restricting movement in and out of the camps, and training medical staff. UNHCR is also increasing its efforts to curb the spread of the virus.

LOOKING FORWARD

Like the rest of the world, Jordan’s status in the battle against COVID-19 is still a day-by-day assessment. Just last month, in mid-September, a new series of shutdown restrictions on public businesses, places of worship, and schools was announced after a rise in regional cases. These restrictions are expected to be lifted by the end of October, and the future of COVID-19 in Jordan, especially in its refugee populations, cannot be predicted. However, Jordan continues to serve as a leader in the Middle East and North Africa for the severity and swiftness of its response, utilization of domestic technological capabilities to bolster its education sector, and inclusion of refugees in healthcare measures.

We urge future researchers to analyze the data on COVID-19 cases through the easing of this current round of restrictions, as well as monitor the testing efforts in refugee populations. The tech-enabled solutions enacted by the Jordanian government seem effective in theory, but we will also want to investigate their participation and adoption rates amongst the student and teacher populations. And finally, as neighboring countries like Yemen face an uphill battle against COVID-19, will Jordan become the go-to country for medical treatment? Recently, we have seen Yemeni patients moved to Jordan for treatment of other conditions such as cancer and kidney disease. We have yet to see if this trend will extend to COVID-19 patients, and if so, it remains unclear whether or not Jordan’s medical/health sector capacities would allow for it.